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ELECTRICAL PERMIT APPLICATION <br /> �CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `�'b'"/ <br /> ti�o�?0/-/OL <br /> 5�3/ as �ti ��� , i�� �����1� w�' �9��3 <br /> PROJECT ADDRESS <br /> 4,7s"- �/c —13� <br /> ttP.o,Qo'� Y�V el -�`�'.�/ �S'�'' -�/v� c✓, (��e��(7' Znt/1� � ��3 <br /> Ovme� Mail Address Cily � State/Zip Phone <br /> Tenant Mail Address Ciry SIa�e2ip Phone <br /> ;�e �..> ,� � �e��/:� � L.c /6 �6 r�c = o� ! �n��� „�� 9,�aa3 <br /> Eleclrical Contractor Mail Address ���G�/� �- ¢it� ��a�e�Z'� �S_„�,�P�°e�(,y <br /> / C <br /> C�c7 <br /> C�o7- ��y - 93o � 11:EF'�j`l2� k lU 6do. � <br /> Stale License Number Conlract Price of Work <br /> Proposed Use of Building Contact Per�on (Plan Review) I <br /> Description of Work to Be Done: oo� a..� �+-e�7�`�7� �'!�l-/— �f. <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED Tp FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certily fhat 1 have read and examined ff�is applicafion and know!he same lo be true and <br /> correcL All provisions o/laws ar�d ordinances goveming this type of work will be_completed <br /> whelher spealed herein or.noL The granfing o/a pennd does not presume to qive aufhonty to <br /> vio/a(e or cancel fhe provisions o/any other sfate or local law regu�ating construction or the <br /> performance o(construclion. That I am authonzed by the owner of this propeRy to peAorm the <br /> work lor which app!ication is made and I comply wdh the S(a(e Confractors Law 18.27 RCW and <br /> 296200 WAC. <br /> /���,.. <br /> - ����:�_ /- a6-�� <br />� ' SignaWre Date <br /> �c4�� -r oz. <br />